Biofeedback of real-time functional magnetic resonance imaging (rt-fMRI) data is a new technique in which the activity in a specific region of a subject's brain is provided as a feedback signal to the subject. The subject can experiment with different cognitive strategies to identify those that are effective in influencing brain activty in the region of interest. By practicing those strategies and monitoring their success, subjects can train themselves to control the target brain region. The proposed research project applies this technique to Tourette Syndrome, a disorder characterized by chronic tics. More specifically, the project examines whether biofeedback of rt-fMRI data can enable adolescents with Tourette Syndrome to develop control over the activity in their supplementary motor area and thereby reduce their tic symptoms. If so, this new technique may yield a low-risk, non-invasive clinical intervention for Tourette Syndrome. In addition, patterns of resting state functional connectivity between brain areas will be examined before and after biofeedback to determine how intrinsic brain dynamics are altered by the intervention, and how those alterations relate to changes in clinical symptoms. This will inform our understanding of the network dynamics underlying tic symptoms. Although this research project is focused on developing a protocol specifically for treating and studying Tourette Syndrome, the methodology has great promise as both a treatment intervention and a research tool for a broad range of neuropsychiatric disorders. PUBLIC HEALTH RELEVANCE: Real-time brain imaging can provide information regarding activity in a specific brain area as it changes over time. By providing Tourette Syndrome patients with this information as a feedback signal, we will train them to control neural activity n their supplementary motor area and examine how that training affects their tic symptoms and their brain function. Although the proposed research develops and applies this method specifically to the treatment and study of Tourette Syndrome, the method has potential therapeutic and investigative utility for a wide range of mental disorders.